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    		NameDescriptionTransaction TypeForm NumberStates
    		Accelerated Benefit Claim Complete to file an accelerated benefit claim. Claims NZ1361 10/22 NY
    		Accelerated Benefit Claim Complete to file an accelerated benefit claim. Claims Z1361 12/23 AK, AL, AR, AZ, CA…
    AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
    		A Consumer's Guide to MIB's Underwriting Services Describes MIB and explains consumer's rights to receive a copy of their record Life Insurance Policy Changes XADV9055 10/22 AK, AL, AR, AZ, CA…
    AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
    		Activation of Lifetime Income Benefit Request Use this form to activate a Lifetime Income Benefit. Other Transactions X4391 08/25 AK, AL, AR, AZ, CA…
    AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
    		Additional Premium Form
    Released: 04/25/2026
    		 Use this form to apply additional funds using your current allocation or to make allocation changes for this deposit and future deposits, if desired. Payments & Deposits V6246 04/26 AK, AL, AR, AZ, CA…
    AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
    		Additional Premium Form
    Released: 06/06/2026
    		 Use this form to apply additional funds using your current allocation or to make allocation changes for this deposit and future deposits, if desired. Payments & Deposits NR6250 06/26 NY
    		Additional Premium Form
    Released: 06/06/2026
    		 Use this form to apply additional funds using your current allocation or to make allocation changes for this deposit and future deposits, if desired. Payments & Deposits R6250 06/26 AK, AL, AR, AZ, CA…
    AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
    		Add-On Benefit Election/Termination Guaranteed Minimum Withdrawal Benefit and Guaranteed Minimum Accumulation Benefit Use this form to add or terminate a GMWB or add a GMAB. Other Transactions V4390 10/24 AK, AL, AR, AZ, CA…
    AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
    		Add-On Benefit Election/Termination Lifetime Income Rider/Lifetime Income Benefit Use this form to add or terminate a Lifetime Income Rider or Lifetime Income Benefit. Other Transactions X4390 12/23 AK, AL, AR, AZ, CA…
    AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
    		Add-On Benefit Election Guaranteed Minimum Withdrawal Benefit Use this form to add a GMWB. Other Transactions NV4390 10/24 NY
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    Annuities are issued by Jackson National Life Insurance Company (Home Office: Lansing, Michigan) and in New York, annuities are issued by Jackson National Life Insurance Company of New York (Home Office: Purchase, New York). Variable products are distributed by Jackson National Life Distributors LLC. May not be available in all states and state variations may apply. These products have limitations and restrictions. Contact the Company for more information. Jackson is the marketing name for Jackson Financial Inc., Jackson National Life Insurance Company and Jackson National Life Insurance Company of New York.

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    Not FDIC/NCUA insured • Not bank/CU guaranteed • May lose value • Not a deposit • Not insured by any federal agency

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    CMC17302 06/25

    Jackson National Life Insurance Company
    1 Corporate Way
    Lansing, MI 48951